[How can the potential of internet- and mobile-based interventions be used in the treatment of depression? Findings from a qualitative survey among German psychotherapists]. / Wie können Potenziale von internet- und mobilbasierten Interventionen in der Versorgung von Depressionen genutzt werden? Erkenntnisse aus einer qualitativen Befragung deutscher Psychotherapeut*innen.

INTRODUCTION AND OBJECTIVES: Internet and mobile-based interventions (IMIs) can reduce the unmet need for treatment of people with depression. The service providers as key actors in the healthcare market play an essential role in implementation. Therefore, the barriers, drivers and expectations from the perspective of psychotherapists were examined. METHODS: In the Nuremberg area, n=15 psychotherapists were interviewed using a semi-structured guideline. The data were then evaluated according to the principles of Grounded Theory. RESULTS: Primarily, optimizing patient benefits and bridging waiting times and aftercare were seen as advantages. Challenges exist in relation to insufficient information and communication channels between those involved in the healthcare market and the resulting lack of therapists' experiences with IMIs. DISCUSSION: In addition to the drivers and barriers, different fields of action must be taken into account in order to increase the implementation of IMIs in the care of people with depression; these include the way that IMIs are integrated into the treatment process, the conception of IMIs and the relationships on the healthcare market. The decisive factor here is to increase cooperation between all those involved in the healthcare market. CONCLUSION: The barriers identified are mainly due to insufficient information and communication channels within the healthcare market. They provide helpful guidance for understanding how the increased implementation of IMIs into the care process in the treatment of depression can succeed.

Web-Based Public Reporting as a Decision-Making Tool for Consumers of Long-Term Care in the United States and the United Kingdom: Systematic Analysis of Report Cards.

BACKGROUND: Report cards can help consumers make an informed decision when searching for a long-term care facility. OBJECTIVE: This study aims to examine the current state of web-based public reporting on long-term care facilities in the United States and the United Kingdom. METHODS: We conducted an internet search for report cards, which allowed for a nationwide search for long-term care facilities and provided freely accessible quality information. On the included report cards, we drew a sample of 1320 facility profiles by searching for long-term care facilities in 4 US and 2 UK cities. Based on those profiles, we analyzed the information provided by the included report cards descriptively. RESULTS: We found 40 report cards (26 in the United States and 14 in the United Kingdom). In total, 11 of them did not state the source of information. Additionally, 7 report cards had an advanced search field, 24 provided simplification tools, and only 3 had a comparison function. Structural quality information was always provided, followed by consumer feedback on 27 websites, process quality on 15 websites, prices on 12 websites, and outcome quality on 8 websites. Inspection results were always displayed as composite measures. CONCLUSIONS: Apparently, the identified report cards have deficits. To make them more helpful for users and to bring public reporting a bit closer to its goal of improving the quality of health care services, both countries are advised to concentrate on optimizing the existing report cards. Those should become more transparent and improve the reporting of prices and consumer feedback. Advanced search, simplification tools, and comparison functions should be integrated more widely.

Transitional Care Model in Germany: Findings from an economic analysis of a randomized controlled trial.

INTRODUCTION: The statutory discharge management system in German hospitals does not provide adequate transitional care for geriatric patients. The American Transitional Care Model (TCM), where a qualified professional supports the patient for a period before, during, and after discharge, could help to address this problem. In this study, we compared both approaches from an economic perspective. Our research questions were: (1) How do treatment costs per person differ when geriatric patients are supported according to the TCM compared with routine discharge management? (2) What are the intervention costs? METHODS: The present economic analysis was part of a randomized controlled trial conducted at a hospital in Germany. In this study, geriatric patients in the intervention group received care according to TCM and those in the control group received routine care. We obtained data from the hospital and a health insurance company. In a cost-cost analysis, we compared the treatment costs per patient incurred in both study groups. In cases where higher costs occurred in the intervention group, we also conducted a cost-utility analysis, using the 12-Item Short Form Survey questionnaire to collect quality of life data for the Quality Adjusted Life Years calculation. Intervention costs were calculated on the basis of staff salaries, working hours, and the cost of acquiring the necessary equipment. RESULTS: The intervention group consisted of 109 geriatric patients, the control group of 119. The average quality of life score was slightly higher in the intervention group, but the difference was not significant. On average, the intervention group was less expensive. However, for individual cost types (e.g., rehabilitation), the intervention group incurred higher costs than the control group. The differences between the study groups were not significant for all cost types (p > 0.05). Intervention costs were estimated to be approximately 800 euros per patient. DISCUSSION: The TCM approach leads to savings. However, the amount of savings will depend on intervention costs, which vary in practice. After outlier exclusion, an unfavorable incremental cost-effectiveness ratio is observed for the TCM approach. CONCLUSION: From an economic perspective, TCM in its present form provides no additional value to patient care compared with routine discharge management. However, we see an urgent need to optimize the existing discharge management system to ensure better transitional care for those affected. Therefore, we recommend that different TCM components should be tested in further studies to address the questions that could not be clarified in the present study.

[Smart sensors in pregnancy: Narrative review on the use of smart home technology in routine prenatal care]. / Smart Sensorik in der Schwangerschaft: Narratives Review über die Verlagerung der Schwangerschaftsvorsorge in den Smart Home Bereich.

INTRODUCTION: Today's routine prenatal care in Germany includes regular in-person appointments of pregnant women with doctors or midwives. Considering an increasing digitalization of the health care sector and in view of the global COVID-19 pandemic, the frequency of in-person visits could be reduced by remote monitoring using smart sensor technology. We aim to give an overview of the current international research on the use of smart sensors in prenatal care and its benefits, costs and resource consumption. METHODS: For this narrative review, PubMed and Science Direct were searched for clinical trials using smart sensors in prenatal care published in English or German language from 1/2016 to 12/2020. We included studies which addressed the benefits, costs and resource consumption of this innovative technology. RESULTS: We identified 13 projects using smart sensors in the fields of basic prenatal care, prenatal care for patients with hypertensive disease in pregnancy and prenatal care for women with gestational diabetes. The projects detected positive effects of smart sensors on health care costs and resource consumption and at least equal benefits for the pregnant women. DISCUSSION AND CONCLUSIONS: The current COVID-19 pandemic underlines the need for the introduction of smart sensor technology into German prenatal care routine. Remote monitoring could easily reduce the frequency of in-person visits by half. Smart sensor concepts could be approved as digital health applications in Germany. In order to increase user acceptance, there should not be any additional costs for pregnant women and health care professionals using modern health care apps. However, health insurance providers need to invest in smart sensor technology in order to eventually benefit from it.

Economic evidence with respect to cost-effectiveness of the transitional care model among geriatric patients discharged from hospital to home: a systematic review.

BACKGROUND: The German hospital-to-home discharge management of geriatric patients has long been criticized. The implementation of the American Transitional Care Model (TCM) could help to reduce readmissions and costs. The objective of this review was to check the scientific evidence of the cost-effectiveness of the TCM. METHODS: A systematic literature search in six databases for the time period of 26 years was conducted. The studies had to meet all pre-defined inclusion criteria. The data extraction is based on a criteria chart from literature. The methodological quality was assessed using the tools of the National Heart, Lung, and Blood Institute as well as the Consensus Health Economic Criteria list. The results transferability to German health care system was explained based on the criteria from the literature. RESULTS: Three American studies met all criteria. They showed partial cost analyses but no full economic analyses. It could be assumed that the economic effect of the TCM changes over time. The costs of a care coordinator could not be determined because few detailed information was reported. The TCM may have negative consequences for hospitals. The results are not transferable to Germany. CONCLUSION: There is no scientific evidence for the cost-effectiveness of the defined TCM. The optimal TCM duration still needs to be clarified. A detailed overview with units and prices and an additional consideration of the hospital perspective could help to make the information more transparent when deciding about the TCM implementation. A full economic analysis under German conditions or for similar European countries is necessary.

[Public Reporting on long-term Care Facilities in Germany: Current State and Evaluation of Quality Information]. / Public Reporting über stationäre Pflegeeinrichtungen in Deutschland: Eine Bestandsaufnahme und Bewertung der Qualitätsinformationen.

OBJECTIVES: Little is known about public reporting on long-term care facilities. In this study, we (1) identify the websites that are available for a search on long-term care facilities in Germany, (2) describe them systematically with regard to general information and range of functions, 3) capture the information on quality available on the websites and 4) evaluate the extent to which they can be useful for those in need. METHODS: 1) Systematic internet search to identify the websites. 2) Analysis of the websites with regard to defined inclusion and exclusion criteria. 3) Data collection from the included websites. 4) Description of the general content and the range of functions of the websites. 5) Collection of quality-related information on long-term care facilities (structure, process and outcome quality, costs, quality inspections results, user feedback). 6) Evaluation of the usefulness of information by analyzing the information using a catalogue of criteria. RESULTS: A total of 24 websites were identified with information on long-term care facilities. Only 4 websites allowed a direct online comparison of several facilities and 17% allowed consumer feedback online. All websites provided information on structural quality, but none on the outcome quality. Across all websites, the usefulness of information for the consumers amounted to 19%. The thematic area on location and accessibility of a facility offered relatively detailed information (79%), while only to 9% was dedicated to the thematic area on care. CONCLUSION: There is a large number of websites that can be searched for information on long-term care facilities. They show a range of heterogeneous functions and information. More websites should offer a function of comparison of multiple facilities. With regard to the information available, consumer preferences do not yet seem to be sufficiently taken into account. Further researches should focus on the evaluation of the impact of outcome quality on decision-making and the analysis of the validity of consumer feedback.

Characteristics and decision making of hospital report card consumers: Lessons from an onsite-based cross-sectional study.

BACKGROUND: Hospitals report cards (HRCs) have had little impact on the hospital choice of patients. Thus, health policy makers should learn more about HRC consumers to better understand how to present and target hospital-related quality information. OBJECTIVE: We sought to learn more about consumers of HRCs and determine the impact of the complexity and tailoring of HRCs on the hospital choice. METHODS: We used primary data drawn from an onsite-based survey, conducted in 2017 at Germany's premier portal, Weisse Liste (N = 635). We performed hierarchical multivariate logistic regression models to identify main predictors associated with hospital choices. RESULTS: HRC consumers differ from the national online population and the national population in general. Eighty percent of those patients or family members, who have used a HRC before, confirmed an impact on the hospital choice. The quality of hospital choices decreased with an increasing level of complexity (p < .001); the latter was identified as a significant predictor for making good choices. However, tailoring HRCs did not have an impact on the quality of the hospital choice (p > .05). CONCLUSIONS: HRCs have a significant impact on the hospital choice among report card consumers. Health policy makers might focus on decreasing the level of complexity; this, more than tailoring report cards, may help consumers make good hospital choices.